Provider Demographics
NPI:1689381428
Name:BLANKENSHIP, KRISTOFER RICHARD (CRM, CADC-R)
Entity Type:Individual
Prefix:
First Name:KRISTOFER
Middle Name:RICHARD
Last Name:BLANKENSHIP
Suffix:
Gender:M
Credentials:CRM, CADC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 3RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-2860
Mailing Address - Country:US
Mailing Address - Phone:541-791-7193
Mailing Address - Fax:
Practice Address - Street 1:433 3RD AVE SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-2860
Practice Address - Country:US
Practice Address - Phone:541-791-7193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT-22-2097101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)